From the Guidelines
Neurological complications of Congenital Diaphragmatic Hernia (CDH) primarily include hypoxic-ischemic brain injury, developmental delays, and cognitive impairments, which can be mitigated with comprehensive neurological monitoring and early intervention services. These complications occur due to several mechanisms: chronic intrauterine hypoxia from lung hypoplasia, postnatal respiratory insufficiency leading to hypoxemia and hypercarbia, hemodynamic instability causing cerebral perfusion fluctuations, and inflammatory responses from extracorporeal membrane oxygenation (ECMO) therapy 1. Infants with CDH should receive comprehensive neurological monitoring including head ultrasounds, MRI brain imaging, and EEG when clinically indicated.
Key Considerations
- Early intervention services should be initiated before discharge, with follow-up developmental assessments at 6,12, and 24 months.
- Specific therapies may include physical therapy for motor delays, speech therapy for feeding and language issues, and occupational therapy for sensory processing and fine motor skills.
- Seizures, which occur in approximately 15-20% of CDH infants, should be treated with appropriate anticonvulsants.
- The severity of neurological complications correlates with the degree of pulmonary hypoplasia, duration of respiratory support, need for ECMO, and presence of associated congenital anomalies, making multidisciplinary care essential for these complex patients.
Management Strategies
- Minimizing peak inspiratory pressure and avoiding large tidal volumes is recommended to reduce ventilator-associated acute lung injury in infants with CDH (Class I; Level of Evidence B) 1.
- High-frequency oscillatory ventilation is a reasonable alternative mode of ventilation for subjects with CDH when poor lung compliance, low volumes, and poor gas exchange complicate the clinical course (Class IIa; Level of Evidence A) 1.
- ECMO is recommended for patients with CDH with severe PH who do not respond to medical therapy (Class I; Level of Evidence B) 1.
From the Research
Neurological Complications of Congenital Diaphragmatic Hernia (CDH)
There are no direct references to neurological complications of CDH in the provided studies. However, we can discuss the general complications and long-term outcomes of CDH:
- Long-term disabilities and complications requiring treatment and follow-up are common in CDH survivors 2
- The main pathophysiology of CDH is respiratory distress and persistent pulmonary hypertension due to pulmonary hypoplasia caused by compression of the elevated organs 2
- CDH is a challenging surgical disease that requires complex preoperative, perioperative, and postoperative care, with numerous complex decisions regarding timing and preparation for surgery 3
- CDH is a developmental discontinuity of the diaphragm, allowing abdominal viscera to herniate into the chest and leading to lung hypoplasia 4
- Fetal intervention for CDH, such as Fetoscopic Endoluminal Tracheal Occlusion (FETO), is a possible treatment option for selected cases 5
Complications and Long-term Outcomes
The provided studies discuss the complications and long-term outcomes of CDH, including: